Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 05 25 627 634 Arezou Ashari Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Dariush Abtahi Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 02 21 2025 02 23 Background: Bimalleolar fractures, which often necessitate surgery due to instability, are linked to considerable postoperative pain. Selective cyclooxygenase-2 (COX-2) inhibitors, like celecoxib, have demonstrated potential in alleviating pain and decreasing the need for opioids. However, the optimal dosing regimen remains unclear. This study compares the efficacy of two celecoxib regimens in reducing postoperative pain after ankle fracture surgery. Methods: A double-blind, randomized controlled trial was carried out with 240 patients undergoing bimalleolar fracture surgery under spinal anesthesia. The participants were split into three groups: a placebo group, a group receiving 400 mg of celecoxib (Group 400), and a group receiving 600 mg of celecoxib (Group 600). Pain levels were evaluated using the Visual Analog Scale (VAS) at specific time points (0, 6, 24, and 72 hours after surgery). Additionally, total morphine consumption, the time until first analgesic use, patient satisfaction, and side effects were documented. Results: Patients in Group 600 experienced significantly lower pain scores and delayed morphine use compared to the placebo group (P < 0.05). Both celecoxib groups consumed less morphine overall, with higher patient satisfaction scores reported in Group 600. Adverse events were minimal and comparable across all groups. Conclusion: The preemptive use of celecoxib, particularly at a 600 mg dose, significantly reduces postoperative pain and opioid use while enhancing patient satisfaction with minimal side effects. These results suggest that COX-2 inhibitors are a practical alternative to opioids for managing pain after ankle fracture surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/1214